By: Brian Hennon
I was recently challenged by someone to think about end-of-life (EOL) conversations through the lens of leadership. Up until that point, I had never looked at these conversations as leadership, but as I have thought more about this, I have realized these conversations do require some significant leadership skills.
Compassion
Good leaders genuinely care about those they lead. There’s an old saying that holds true: people don’t care what you know until they know you care. This is a key to being a good leader and also to engaging on EOL conversations.
Years ago I was in a hospital room and a young doctor came in and began sharing bad news with the family. It was all very academic and cold and I could sense the tension rising when suddenly, the patient’s son interrupted and asked for a different doctor.
Contrast that with another doctor I have worked with who understands that leading people to understand what is happening with their health requires compassion and even approval. He will regularly ask the patient and family for permission to ask difficult questions and share difficult information.
While he is there to do a job, he makes sure to show his patients he cares. As a result, he earns the right to be heard. That is leadership.
Courage
EOL conversations are incredibly uncomfortable. What makes them really difficult is, unfortunately many patients have bounced from specialist to specialist, doctor to doctor, and no one has really been up front about their condition. No one has told them their illness is severe. No one has told them they are dying. Either that or they have been told and were simply unwilling or unable to hear.
Many times, I have been asked to call a family or walk into a patient’s room to talk about EOL care only to find out no one has actually told the patient or family how severe things are. It is at those moments when EOL professionals have to lead with courage.
Leaders have to share challenging, uncomfortable information at times. It is the nature of the job. They have to be willing and able to share the truth even when that truth is difficult to hear. Shrinking back from that task will only cause more pain and frustration.
Within the framework of courage come a host of other values.
The courage to lead and speak with integrity.
Overpromising, exaggeration, half-truths, or manipulation, may get the quick results, but they will eventually lead to long-term problems.
The courage to be honest when telling the truth is hard.
Honesty is the cornerstone to effective EOL conversations and effective leadership. When leaders bend the truth to achieve a goal or to make themselves appear more effective than they are, it leads to distrust and good employees leaving.
The courage to make unpopular decisions.
Leadership has its perks, but it also comes with a cost. One of the prices to pay is making decisions people do not like. Leaders who seek to be liked or appreciated more than being effective will get neither. Leaders who have a reputation for making tough decisions, may not be liked, but they will eventually be respected and effective.
The courage to stand up for what’s right.
There are times when healthcare decisions are made on behalf of patients that are not in their best interest. A good EOL educator will not only education, but also advocate.
Sometimes decisions are made in an organization, that make achieving goals or simply doing a job difficult. Leaders who stand up for what is right do so even when it may mean falling out of favor.
Hope
Life is unpredictable. I have frequently spoken to patients and families who felt blindsided by a diagnosis. They were scared. They were devastated. They felt hopeless.
One of the most difficult tasks of an EOL educator is to help people find hope in what looks like hopeless situations. Our role is not to deny or ignore the reality of the situation. That would be dishonest and disingenuous. One of our jobs is to help those involved find hope and that can take many forms.
Hope in less pain.
Hope in the promise of eternity.
Hope in fewer trips to the hospital.
Hope they can have more quality of life.
This is a quality of good leaders as well. Organizations are unpredictable, just like life in general, and it is the job of a leader to be the calm in the storm. Leaders keep their teams focused, help find solutions, and even help them find hope.
Good leaders do not pretend problems and concerns do not exist, but they help their teams find some light in the midst of circumstances that seem dark. They help them see beyond where they are and reach for new heights.
Leadership is tough, but keeping these principles in mind can and will make leaders more effective and more impactful.
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